Advanced Search

Neurosurgery Coding Alert

READER QUESTIONS:

Reduced Craniectomy Warrants 52

Published on Tue Jul 12, 2005

Question: Our surgeon removed a basal cell carcinoma that extended below the skin to the skull, which required partial excision of the outer table of the skull. How can we code for this?


Pennsylvania Subscriber
Answer: In this case, you should report 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) and append modifier 52 (Reduced services).

The craniectomy code assumes a full-thickness procedure, and applying modifier 52 acknowledges that the surgeon only excised a portion of the skull's outer table.

When you append modifier 52 to a claim, you should tell the payer why. Include a cover letter - as well as the operative report - with your claim to explain the extenuating circumstances that caused the physician to reduce the procedure.

You need not lower your fees when submitting a claim with modifier 52. Rather, provide as much documentation as possible and allow the payer to make a determination based on the information you submit.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Neurosurgery Coding Alert

View All